Standards of laboratory practice: analgesic drug monitoring

White, Suzanne; Wong, Steven H.

doi:10.1093/clinchem/44.5.1110

Cited by 30 publications

(10 citation statements)

References 79 publications

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“…The assumed range of therapeutic serum levels of ibuprofen in elephants is based on published ranges for humans. The average dose given to humans is 7 mg/kg, therapeutic serum concentrations range between 15 and 30 mg/L, 26 and the half-life is 2 hr. 1 The S(ϩ) isomer of ibuprofen is reported to be twice as potent as the racemic mixture in its analgesic and anesthetic properties.…”

Section: Discussionmentioning

confidence: 99%

“…Diurnal variations in drug metabolism have been documented for antiinflammatory agents. 26 For example, peak serum concentrations of naproxen in humans were delayed when the same dose was administered orally in the morning versus evening hours. 19 This is likely associated with diurnal variations in serum concentrations of cortisol, which are typically higher in the morning in elephants as well (Bechert, unpubl.…”

Section: Discussionmentioning

confidence: 99%

“…There is some indication that species differences in drug metabolism exist between African and Asian elephants, although this has not been substantiated. 16,22 Furthermore, variations in drug metabolism have been reported in certain species based on time of administration (i.e., diurnal variation) 26 and gender. 24 For effective management of pain and inflammation in elephants, administration of NSAIDS should occur when drug absorption is maximal and at a frequency that minimizes fluctuations in drug concentrations through time.…”

Section: Introductionmentioning

confidence: 99%

“…16 The average dose given to humans is 7 mg/kg, and therapeutic serum concentrations range between 15 and 30 mg/L. 26 Chronic use of ibuprofen can lead to impairment of hepatic or renal function, 26 or cause upper gastrointestinal tract bleeding, 3 necessitating determination of safe and therapeutic dosing regimens for elephants. The objectives of our research were 1) to determine the pharmacokinetic parameters of S(ϩ) ibuprofen and R(Ϫ) ibuprofen after oral administration of racemic ibuprofen to elephants, 2) to compare values between elephant species as well as between males and females, and 3) to design therapeutic dosing regimens that maintain serum ibuprofen concentrations at or slightly above levels known to be efficacious in other species for treatment of musculoskeletal disorders and inflammatory conditions.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of Orally Administered Ibuprofen in African and Asian Elephants (Loxodonta Africana and Elephas Maximus)

Bechert¹,

Christensen²

2007

Journal of Zoo and Wildlife Medicine

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The pharmacokinetic parameters of S(+) and R(-) ibuprofen were determined in 20 elephants after oral administration of preliminary 4-, 5-, and 6-mg/kg doses of racemic ibuprofen. Following administration of 4 mg/kg ibuprofen, serum concentrations of ibuprofen peaked at 5 hr at 3.9 +/- 2.07 microg/ml R(-) and 10.65 +/- 5.64 microg/ml S(+) (mean +/- SD) in African elephants (Loxodonta africana) and at 3 hr at 5.14 +/- 1.39 microg/ml R(-) and 13.77 +/- 3.75 microg/ml S(+) in Asian elephants (Elephas maximus), respectively. Six-milligram/kilogram dosages resulted in peak serum concentrations of 5.91 +/- 2.17 microg/ml R(-) and 14.82 +/- 9.71 microg/ml S(+) in African elephants, and 5.72 +/- 1.60 microg/ml R(-) and 18.32 +/- 10.35 microg/ml S(+) in Asian elephants. Ibuprofen was eliminated with first-order kinetics characteristic of a single-compartment model with a half-life of 2.2-2.4 hr R(-) and 4.5-5.1 hr S(+) in African elephants and 2.4-2.9 hr R(-) and 5.9-7.7 hr S(+) in Asian elephants. Serum concentrations of R(-) ibuprofen were undetectable at 24 hr, whereas S(+) ibuprofen decreased to below 5 microg/ml 24 hr postadministration in all elephants. The volume of distribution was estimated to be between 322 and 356 ml/kg R(-) and 133 and 173 ml/kg S(+) in Asian elephants and 360-431 ml/kg R(-) and 179-207 ml/kg S(+) in African elephants. Steady-state serum concentrations of ibuprofen ranged from 2.2 to 10.5 microg/ml R(-) and 5.5 to 32.0 microg/ml S(+) (mean: 5.17 +/- 0.7 R(-) and 13.95 +/- 0.9 S(+) microg/ml in African elephants and 5.0 +/- 1.09 microg/ml R(-) and 14.1 +/- 2.8 microg/ml S(+) in Asian elephants). Racemic ibuprofen administered at 6 mg/kg/12 hr for Asian elephants and at 7 mg/kg/12 hr for African elephants results in therapeutic serum concentrations of this antiinflammatory agent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of Orally Administered Ibuprofen in African and Asian Elephants (Loxodonta Africana and Elephas Maximus)

Bechert¹,

Christensen²

2007

Journal of Zoo and Wildlife Medicine

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“…Understanding drug testing procedures is the third important part of dealing with patients suspected of misusing analgesics. White and Wong have offered a general template to determine when drug testing may be used in a clinical setting to monitor analgesic drug therapy 3 . They suggest that screening should take place when either compliance or abuse of a drug is in question.…”

Section: Commentsmentioning

confidence: 99%

Laboratory Monitoring of OxyContin (Oxycodone): Clinical Pitfalls

et al. 2004

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Some patients have headaches that are refractory to standard treatments, and they require chronic administration of opioid analgesics. The use of opioids in a clinical setting must be closely monitored due to the medications' potential for addiction, abuse, and fatal interactions. Limited access to opioids and the demand for them outside the clinical setting leads to another danger. Patients can mislead their providers into prescribing opioids, intending to sell the medications instead of using them to alleviate their own pain. For protection of the patient, as well as the community, it is vital that such activity be prevented. We recently encountered a patient we suspected of abusing or misusing OxyContin (oxycodone). In order to determine whether the patient was taking the medication as prescribed, we ordered a urine-based immunoassay drug screen. The results were negative; the patient appeared to not have oxycodone in his system. Based on these results, we dismissed the patient from our practice. At the patient's request, a second test was performed, this time using gas chromatography-mass spectrometry. It indicated that the patient did indeed have sufficiently high levels of oxycodone in the urine. The minimum level threshold was too high to detect the presence of oxycodone in the immunoassay. We would like to help prevent future misunderstandings such as we experienced. To do so, we will first present the case of our patient, followed by a discussion of the actions taken. Finally, we will provide an overview of analgesic monitoring systems.

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Overdose, Poisoning, and Envenomation

Gei¹,

Suarez²

2004

Critical Care Obstetrics

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Standards of laboratory practice: analgesic drug monitoring

Cited by 30 publications

References 79 publications

Pharmacokinetics of Orally Administered Ibuprofen in African and Asian Elephants (Loxodonta Africana and Elephas Maximus)

Pharmacokinetics of Orally Administered Ibuprofen in African and Asian Elephants (Loxodonta Africana and Elephas Maximus)

Laboratory Monitoring of OxyContin (Oxycodone): Clinical Pitfalls

Overdose, Poisoning, and Envenomation

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